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Original research
Outcomes in patients with moderate and asymptomatic severe aortic stenosis followed up in heart valve clinics
  1. Pasquale Paolisso1,2,
  2. Monika Beles1,
  3. Marta Belmonte1,2,
  4. Emanuele Gallinoro1,
  5. Cristina De Colle1,2,
  6. Niya Mileva1,
  7. Dario Tino Bertolone1,2,
  8. Celine Deschepper1,
  9. Jerrold Spapen1,
  10. Sofie Brouwers1,3,
  11. Ivan Degrieck4,
  12. Filip Casselman4,
  13. Bernard Stockman4,
  14. Frank Van Praet4,
  15. Martin Penicka1,
  16. Carlos Collet1,
  17. Eric Wyffels1,
  18. Marc Vanderheyden1,
  19. Emanuele Barbato1,2,
  20. Jozef Bartunek1,
  21. Guy Van Camp1
  1. 1Cardiology Department, Hartcentrum OLV Aalst, Aalst, Belgium
  2. 2Department of Advanced Biomedical Sciences, Federico II University Hospital, Napoli, Campania, Italy
  3. 3Department of Experimental Pharmacology, Vrije Universiteit Brussel, Brussel, Belgium
  4. 4Department of Cardiovascular Surgery, Hartcentrum OLV Aalst, Aalst, Belgium
  1. Correspondence to Professor Guy Van Camp, Cardiology Department, Hartcentrum OLV Aalst, Aalst, Belgium; guy_vancamp{at}outlook.com

Abstract

Background Heart valve clinics (HVC) have been introduced to manage patients with valvular heart disease within a multidisciplinary team.

Objective To determine the outcome benefit of HVC approach compared with standard of care (SOC) for patients with moderate and asymptomatic severe aortic stenosis (mAS and asAS).

Methods Single-centre, observational registry of patients with mAS and asAS with at least one cardiac ambulatory consultation at our Cardiovascular Centre. Based on the outpatient strategy, patients were divided into HVC group, if receiving at least one visit at HVC, and SOC group, if followed by routine cardiac consultations.

Results 2129 patients with mAS and asAS were divided into those followed in HVC (n=251) versus SOC group (n=1878). The mean age was 76.5±12.4 years; 919 (43.2%) had asAS. During a follow-up of 4.8±1.8 years, 822 patients (38.6%) died, 307 (14.4%) were hospitalised for heart failure and 596 (28%) underwent aortic valve replacement (AVR). After propensity score matching, the number of consultations per year, exercise stress tests, brain natriuretic peptide (BNP) determinations and CTs were higher in the HVC cohort (p<0.05 for all). A shorter time between indication of AVR and less advanced New York Heart Association class was reported in the HVC cohort (p<0.001 and p=0.032). Compared with SOC, the HVC approach was associated with reduced all-cause mortality (HR=0.63, 95% CI 0.40 to 0.98, p=0.038) and cardiovascular death (p=0.030). At multivariable analysis, the HVC remained an independent predictor of all-cause mortality (HR=0.54, 95% CI 0.34 to 0.85, p=0.007).

Conclusions In patients with mAS and asAS, the HVC approach was associated with more efficient management and outcome benefit compared with SOC.

  • aortic valve stenosis
  • heart valve diseases
  • outcome assessment, health care
  • transcatheter aortic valve replacement

Data availability statement

Data are available on reasonable request.

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Footnotes

  • Twitter @EGallinoro, @EricWyffels

  • Contributors MBele and PP carried out the statistical analysis. PP and MBelm wrote the first draft of the manuscript. EG, CDC, NM, DTB, CD, JS and SB collated data. JS, SB, ID, FC, BS, FVP, MP, CC, EW, MV, EB, JB and GVC corrected and approved the revisions and final version of the manuscript. GVC, PP and MBelm are responsible for the conception, funding and design of the study. GVC is the guarantor of this work.

  • Funding PP, MBelm and DTB report receiving a research grant from the CardioPaTh PhD Program.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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